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Joel S. Corvera
Cullen D. Morris
Jason M. Budde
Daniel A. Velez
John D. Puskas
Omar M. Lattouf
William A. Cooper
Robert A. Guyton
Jakob Vinten-Johansen
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Right arrow Coronary disease

J Thorac Cardiovasc Surg 2003;126:1549-1554
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Pretreatment with phenoxybenzamine attenuates the radial artery's vasoconstrictor response to {alpha}-adrenergic stimuli

Joel S. Corvera, MDa, Cullen D. Morris, MDa, Jason M. Budde, MDa, Daniel A. Velez, MDa, John D. Puskas, MDa, Omar M. Lattouf, MDa, William A. Cooper, MDa, Robert A. Guyton, MDa, Jakob Vinten-Johansen, PhDa,*

a Cardiothoracic Research Laboratory, Division of Cardiothoracic Surgery, Carlyle Fraser Heart Center at Crawford Long Hospital, Emory University School of Medicine, Atlanta, Ga, USA

Received for publication November 19, 2002; revisions received February 10, 2003; revisions received April 16, 2003; accepted for publication April 24, 2003.

* Address for reprints: Jakob Vinten-Johansen, PhD, Cardiothoracic Research Laboratory, Carlyle Fraser Heart Center, 550 Peachtree St, NE, Atlanta, GA 30308-2225, USA
jvinten{at}emory.edu

BACKGROUND: Although the radial artery bypass conduit has excellent intermediate-term patency, it has a proclivity to vasospasm. We tested the hypothesis that brief pretreatment of a radial artery graft with the irreversible adrenergic antagonist phenoxybenzamine attenuates the vasoconstrictor response to the vasopressors phenylephrine and norepinephrine compared with the currently used papaverine/lidocaine.

METHODS: Segments of human radial artery grafts were obtained after a 30-minute intraoperative pretreatment with a solution containing 20 mL of heparinized blood, 0.4 mL of papaverine (30 mg/mL), and 1.6 mL of lidocaine (1%). The segments were transported to the laboratory and placed into a bath containing Krebs-Henseleit solution and 10, 100, or 1000 µmol/L phenoxybenzamine or vehicle. The segments were tested in organ chambers for contractile responses to increasing concentrations of phenylephrine and norepinephrine (0.5-15 µmol/L).

RESULTS: Contractile responses to 15 µmol/L phenylephrine in control radial artery segments averaged 44.2% ± 9.1% of the maximal contractile response to 30 mmol/L KCl. Papaverine/lidocaine modestly attenuated contraction to 15 µmol/L phenylephrine (32.1% ± 5.9%; P = .22), but 1000 µmol/L phenoxybenzamine completely abolished radial artery contraction (-7.2% ± 4.4%; P < .001). The effect of 10 and 100 µmol/L phenoxybenzamine on attenuating vasocontraction was intermediate between 1000 µmol/L phenoxybenzamine and papaverine/lidocaine. Responses to 15 µmol/L norepinephrine in control radial artery segments averaged 54.7% ± 7.5% of maximal contraction to 30 mmol/L KCl. Papaverine/lidocaine modestly attenuated the contraction response of radial artery segments (35.6% ± 5.1%; P = .04). In contrast, 1000 µmol/L phenoxybenzamine showed the greatest attenuation of norepinephrine-induced contraction (-10.5% ± 2.0%; P < .001).

CONCLUSIONS: A brief pretreatment of the human radial artery bypass conduit with 1000 µmol/L phenoxybenzamine completely attenuates the vasoconstrictor responses to the widely used vasopressors norepinephrine and phenylephrine. Papaverine/lidocaine alone did not block vasoconstriction to these {alpha}-adrenergic agonists.




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